Practice Essentials

Balanitis is inflammation of the glans penis
[1] and is a common condition affecting an estimated 3-11% of males. Balanitis can occur in males at any age. Morbidity is associated with the complications of phimosis.
[2, 3, 4] Balanitis involving the foreskin and prepuce is termed balanoposthitis. According to European guidelines outlining the current management of balanoposthitis, the aims of management are to minimize sexual dysfunction and urinary dysfunction, exclude penile cancer, treat premalignant disease, and diagnose and treat STIs.

Predisposing factors include poor hygiene and overwashing, use of over-the-counter medications, and nonretraction of the foreskin.
[5] Though uncommon, a complication of balanitis (usually only in recurrent cases) is constricting phimosis, or inability to retract the foreskin from the glans penis. Other complications of balanitis may include meatal stenosis and possible urethral strictures; urinary retention; and vesicoureteral reflux.

Uncircumcised men with poor personal hygiene are most affected by balanitis. Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema. Though uncommon, complications of balanitis include phimosis and cellulitis. Meatal stenosis with urinary retention may rarely accompany balanitis. In very few cases, balanitis may contribute to the "buried penis syndrome." Diabetes is the most common underlying condition associated with adult balanitis.
[11, 12, 13] Older age has been identified as a risk factor for candidal balanitis. Zoon’s balanitis is a disease of older men who are uncircumcised.
[5]

If the patient is able to retract the foreskin and does not have uncontrolled diabetes, he may be discharged to follow up with a urologist.

Bacitracin should be used for children, and clotrimazole in adults, and possibly a steroid cream.

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center